Asthma nurse practice in primary health care : quality, costs and outcome

Abstract: The primary aim of the present work was to document and analyse whether it is beneficial to patients and to the health care sector to organise asthma care in primary health care is  the form of asthma nurse practices (ANPs). During the past decade ANPs have been established in primary health care in the county of Östergatland, Sweden. The prevalence of asthma is increasing in the industrialised world, and this focuses attention on the efficacy and quality of asthma care.The methods, data collection and measurements that were used can be summarised as follows. The studies included: (i) a prospective intervention study (ANP concept) with pre- and post- test comparisons, objective measurements and patient questionnaires; (ii) further development of a patient questionnaire, validation of items by structured followHup telephone interviews using predetermined criteria; (iii) comparison of quality and cost in two different approaches to providing asthma care within primary health care, traditional care and care given at a primary health care centre with an ANP, by combining a retrospective review of documentation in patient records using a special form and a prospective approach using a patient questionnaire; (iv) semi-structured interviews with asthma patients to obtain their view of asthma care and clarify factors of importance for compliance with prescribed medication.The evaluation demonstrated that on the group level, primary health care centres with ANPs resulted in better disease control, fewer asthma symptoms, and better patient experienced knowledge and self-management outcomes. The results also showed fewer emergency visits, better documentation of asthma management and better asthma quality outcomes. It was also found that health care costs were lower with the ANP than with traditional asthma care in primary health care. The patients expressed important aspects of the care as the need for security, including regular asthma check-ups, easy access to care, continuity in the care, competence ofthe health care staff, and information and knowledge about asthma. Increasing age, female gender, long duration of the disease, the attitude of the staff, and whether patients felt they had obtained information and education about asthma were all factors of importance for compliance with prescribed medication.The main conclusion of the thesis was that the ANP concept seems to improve asthma care in primary health care and resulted in economic advantages for the health care sector.